Your blog post completed, factor 50 sun cream packed, antimalarials started and the last of the jabs completed. People have given, prayed and waved you off, then three months later you're back at work in the NHS, photo adventures uploaded on Facebook and the feel of warm sunshine a distant memory. Why would anyon e go long term?

At a recent Malawi Christian Medical Dental Fellowship national conference, Dr Bert Nanninga presented his lessons learned from 18 years of health work in rural Malawi. I was left stirred , quietly contemplating the contrasts with several recent articles in Triple Helix focusing on short term and even 'ultra short term' missions opportunities. (1) I had begun to wonder whether, with easy travel, modern communications and the current career demands in the NHS, short term missions are the 'way to go'. Perhaps we are at the end of an era of people choosing long term work overseas. But I was made to think again by a visitor from the UK who came to see me in my office. She was non-medical, working with a faith-based organisation that supports a variety of programmes including some health-related work. She said: 'I'm out here for two years now but would really like to think about long term, I think there's so much more you can achieve when you really get to know people.' So it seems there are still people choosing to be 'in it for the long term'.

How long is 'long term'?

When we first set off for a planned two years in a South African district hospital in 1999 it certainly felt like long term, but when we came to leave, we felt as if we were just about getting the hang of who was who, how things worked and what our priorities might be. A further year at All Nations Christian College in Hertfordshire confirmed that there was plenty to think about in cross-cultural life and mission. Should five years or more be considered long term? It's long enough to have to get your address changed with the Post Office.

It took me seven years in Malawi to manage a basic consultation in the local language, and as we near the ten year mark there's plenty to try to figure out almost every day. What would you expect if someone – let's say from Japan – arrived in the UK offering to 'help serve the health care system for one year'. How much time do you think they would need to get to grips with language, culture, local systems and practices, let alone bring about any change?

Is long term service realistic in the 21st century?

Having worked outside the NHS for some time it is difficult to comment on the current structures of training programmes and their relative flexibility/inflexibility, but every generation presents its own set of challenges to going overseas, and sorting out your approach to your career is certainly one of them. As Christians we are no longer to think with the same mindset as the world. We have been called by Jesus to give up 'everything' in order to be his disciples. (2) The great news is that firstly, God is 'faithful', and secondly, Jesus is 'the same yesterday, today and forever', (3) so if you feel God is calling you to long term overseas service, don't be dismayed by the seemingly insurmountable hurdles or the fact that everyone around you thinks you are nuts! There are certainly many examples in scripture of God using small people to do big things.

It is important to be adequately trained and prepared so that you can make a useful contribution to medical service, though not all of that preparati on has to be, or even should be, in the UK. Opportunities for short term mission trips are useful as preparation. They build medical skills relevant for a non-UK setting whilst testing out other equally important issues such as your personality, your family's willingness to let you go, and perhaps how closely your dream of life abroad fits the reality.

Is long term service desirable?

Longer term commitment reaps far deeper rewards than short term trips. These are often about the 'go-er' and what they will learn (4) while someone somewhere arranges the logistics to make the short term time effective. As far as possible short term trips should be done with nationals, either in leadership or, at least, as equal members of your team. This will help you (and any intended impact of your work) in numerous ways: you share your technical skills whilst relying on local expertise and follow up.

Many non-UK cultures are heavily relationshipbased. Duane Elmer, in his challenging book Cross Cultural Servanthood, quotes from a Canadian International Development Agency study which found that the number one factor determining overseas effectiveness was the ability to build long term relationships with local people. (5) People from the West (or more task-driven societies) may find this approach wrong or frustrating, especially when the needs (and possibly the solutions) are so 'glaringly obvious', but you have to spend time getting to know people – the nurses on the wards, the hospital director, your head of department – if you want to get things done. With time the 'glaringly obvious' may turn out to be something different to what you had initially supposed. It is easier to 'do no harm' in the host situation when time is not of the essence. How much are we in danger of disempowering the local community by our short term activity? It's part of developing respect for your host culture and learning some of your own cultural frailties in the process! By the power of the Holy Spirit we are moulded and shaped, hopefully bringing more of God's transforming wisdom, gentleness and love.

Is long term service really necessary?

There are many missionary tales from days gone by of courageous men and women who set off from these shores by steam ship; tales of heroism and sacrifice as people succumbed to a range of tropical illnesses in faraway places, with seeds of faith and prayer planted, resulting in changed hearts over many years.

So what about now? In Malawi many people have heard the gospel, and statistics reveal a thoroughly 'Christian-ised' country. At our hospital we witness nurses spending hours at the nurses' station reading their Bibles and patients assailed by noisy lunchtime prayers. Part of our role, working alongside our local colleagues, is to demonstrate the daily, practical outworking of God's love by providing high quality, ethical practice to patients and their families. The same basic principle is relevant in many overseas environments. Each place will present its own specific challenges; in many, open proclamation of the gospel may be very difficult.

Several aspects of medical service here in Blantyre, including the medical school, children's orthopaedics, palliative care, malaria and HIV research, have flourished as a result of partnerships between long term Christian medical workers and Malawian nationals. The medical school is still young and rapidly expanding providing a ripe opportunity for young Christian doctors to have their lives shaped by role modelling and friendship. What a privilege it is to be around long enough to see some of these fruits and to input them into the next generation of doctors.

Is long term service more biblical?

I started off thinking that long term service is superior to short term visits. On reflection that may be based more on my pride rather than scripture! Jesus managed his earthly ministry in three years. There is nothing superior in spending 40 years or so outside of your home culture, but being in the place that God wants us is surely best.

In it for the long term?

For me, being in Malawi for ten years has been enriching, humbling, challenging and immensely rewarding. We have put down roots and made friendships that have grown and deepened over the years. We plan to be there for several years to come – definitely 'in it for the long term.'

Jane Bates has spent the last 13 years working overseas, firstly in South Africa and subsequently in Malawi where she has established an adult palliative care service in the national teaching hospital in Blantyre. She is involved in the Christian Medical and Dental Fellowship of Malawi.